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Community-wide Interventions to Increase Physical Activity: What's the Evidence?
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Community-wide Interventions to Increase Physical Activity: What's the Evidence?

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Health Evidence hosted a 90 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on community-wide interventions for increasing physical activity. Key messages and …

Health Evidence hosted a 90 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on community-wide interventions for increasing physical activity. Key messages and implications for practice were presented on Wednesday January 30, 2013 at 1:00 pm EST.

This webinar focused on interpreting the evidence in the following review:
Baker, P., Francis, D., Soares, J., Weightman, A., Foster, C. Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews, 2011(4): Art. No.: CD008366.

Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Philip Baker, the first author of this review.


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  • 1. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! Community-wide Interventions for Increasing Physical Activity:What’s the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  • 2. What’s the evidence? Baker, P.R.A., Francis, D.P., Soares, J., Weightman, A.L. & Foster, C. (2011). Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews, Issue 4. Art. No.:CD008366. DOI: 10.1002/14651858.CD008366.pub2. http://www.health-evidence.ca/articles/show/21588
  • 3. Participant Side PanelHousekeeping in WebEx Use Q&A to post comments/questions during the webinar  ‘Send’ questions to All (not privately to ‘Host’) Connection issues  Recommend using a wired Internet connection (vs. wireless), to help Q&A prevent connection challenges WebEx 24/7 help line: 1-866-229-3239
  • 4. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! Community-wide Interventions for Increasing Physical Activity:What’s the evidence?
  • 5. The Health Evidence Team Kara DeCorby Heather Husson Jennifer Yost Managing Director Project Manager Guest PresenterMaureen DobbinsScientific DirectorTel: 905 525-9140 ext 22481E-mail: dobbinsm@mcmaster.ca Lori Greco Robyn Traynor Lyndsey McRae Knowledge Broker Research Coordinator Research Assistant
  • 6. What is www.health-evidence.ca? Evidence inform Decision Making
  • 7. Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  • 8. Knowledge Translation Supplement Project CIHR-funded KTB-112487
  • 9. Philip Baker Professor of Epidemiology, School of Public Health and Social Work, Queensland University of Technology, Brisbane Australia
  • 10. Review Baker, P.R.A., Francis, D.P., Soares, J., Weightman, A.L. & Foster, C. (2011). Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews, Issue 4. Art. No.:CD008366. DOI: 10.1002/14651858.CD008366.pub2.
  • 11. Authors and affiliations Professor Dr Philip Baker – QUT Daniel Francis – Queensland Health / QUT Prof Alison Weightman – Cardiff University, Wales Dr Charlie Foster – Oxford University, UK Dr Jesus Soares – CDC, USA
  • 12. Questions?
  • 13. Summary Statement:Baker(2011) P General population, i.e. communities. I Community wide, multi-strategic interventions with at least two strategies aimed at promoting physical activity. C Usual practice. O Population levels of physical activity.Quality Rating: 9 (strong)
  • 14. Included intervention s:Multi-strategic interventions that aim to reach the whole community, which must have included at least 2 of a possible 6 components: social marketing; other communication strategies; individual counselling by health practitioners; partnerships with government or non-government groups; working in specific settings; and environmental change strategies.
  • 15. Overall Considerations Insufficient evidence, most included studies at high risk of bias. Serious issues in the design affecting their trustworthiness There may be efficacious approaches Different interventions seemed to reach different segments of the population. Some studies showed positive effect, others decreased or no effect High intensity interventions did not necessary result in more effective interventions
  • 16. General ImplicationsPublic health should promote/support/implement: Can not assume combining interventions will yield a measurable health outcome. Should not group label “evidence-based”. There is a need for more robust studies to investigate community wide interventions. Need to measure PA accurately, continuous measures best. New studies should be rigorously designed and analysed and should include process evaluations Consider individual components e.g. School-based
  • 17. General implications Robust, continuous measurement better Might be promise in the environmental strategies long term perspective Reaching whole community difficult
  • 18. Public health should consider that… Interpretation limited by the included studies many at high risk of bias  Selection bias- e.g. “purposely” different communities, “head start”  Detection –poor outcome measurement, low response rate  Reporting bias – outcomes measured – but missing
  • 19. What’s the evidence?Outcomes reported in the review Dichotomous outcomes  % Physical activity  % Not sedentary  % Leisure time physical activity Continuous outcomes  Time physically active  Walking  METs (energy expenditure)
  • 20. What the review found There was much variation in interventions, population and outcomes. The results of the studies themselves were inconsistent, making it especially difficult to identify the key, reliable findings. Few studies reported a substantial or sustained increase in physical activity There was no evidence that more intense interventions worked better then others.
  • 21. What the review found Countries of origin USA 8 Demark 1 China 4 Finland 1 Australia 2 France 1 Netherlands 2 Iran 1 Norway 2 Pakistan 1 Canada 1 Belgium 1
  • 22. What the review foundincluded strategies Building partnership (22 studies) Some form of counselling (18) Mass media (15) Other communication (18) Specific settings (11) Environmental change strategies (10)
  • 23. Dichotomous outcomes – Physical activity 2.5Favours intervention 2 1.5 1Favours control 0.5 0 Wendel-Vos Reger-Nash Brown 2006 Lupton 2003 Sarrafzadegan Kloek 2006 NSW Health Jiang 2008 2009 2005 2009 2002
  • 24. Dichotomous outcomes –Physical activity during leisure time 1.4Favours intervention 1.3 1.2 1.1 1Favours control 0.9 0.8 0.7 0.6 Nishtar 2007 Kumpusalo 1996 Luepker 1994a Luepker 1994b
  • 25. Dichotomous outcomes –Sedentary or physically inactive 3 2Favours control 1Favours intervention 0 Jenum 2006 Nafziger 2001 Osler 1993 Goodman
  • 26. Continuous outcomes 7 included studies 3 showing some evidence (DeCocker 2007 (women), Simon 2008, Wendel- Vos 2009 Measured a against background decreasing PA levels Continuous measures more useful
  • 27. Continuous measures –Leisure time spent in PAStudy Measure Subgroups Post-mean Adjusted Adjusted % (labelled) difference mean change difference relative to the control meanWendel-Vos Leisure time Men -0.2 -0.4 -2.06 2009 PA (hours/wk) Women -0.7 2.2 14.01 (P<0.5)DeCocker 2008 Leisure time Leisure time 0 32 25.60 PA PA (P<0.05) (min/week)Simon 2008 Supervised Children 0.9 1.1 43.14 leisure time only (P<0.0001) PA measured
  • 28. Continuous outcomeswalkingStudy Measure Sub-groups Post mean Adjusted Adjusted % (labelled) difference mean change difference relative to the control meanWendel-Vos Walking Men 1.8 1.1 15.94 NS2009 (hours/week) Women 1.8 2.0 29.41 NSDeCocker Walking Walking 34 47 17.342007 (min/week) (P<0.05)Brownson Walking N/A -0.8 5.2 4.75 NS2005 (mean min/week)Brownson 7 day total N/A -5.3 -1.4 -1.38 NS2004 walking (mean
  • 29. Continuous outcomes –Energy expenditure METsStudy Measure Post mean Adjusted Adjusted % (labelled) difference mean change difference relative to the control meanSarrafzegan Total daily PA 32 46 9.09 (P<0.05)2009 (MET –m/week +SD) Leisure time PA 14 13 12.26 (P<0.01) (MET- m/week)Kloek 2006 METs/week 81 -241 -3.54 (P=0.95)
  • 30. Intensity of theIntervention 9 high intensity 10 medium intensity 6 low intensity Interventions by Gu 2006, Jiang 2008, and Zhang 2003 reached every individual in their target communities
  • 31. High intensity studiesOf the 9 studies assessed of high intensity 5 of these reported some improved PA outcomes 3 of these found no effects Some high intensity interventions not appropriate for western settings
  • 32. Environmental – possible? Brown -2006 (wide range) women Brownson 2004 (walking trails) De Cocker 2007 (signage) Eaton 1999 (trails, paths) Goodman 1995 (walking trails) Jenum 2006 (approaches) maybe Leupker 1994 (change) NSW Health 2002 (parks) maybe O’Loughlin 1999 (minimal)
  • 33. General Implications Review is a foundation of relevant evidence Reviews of specific components Environmental change strategies and settings based approaches may provide a promising direction for future interventions Incorporation of strong evaluation designs
  • 34. Take home messages Many of the included studies had significant methodological issues The effects reported from the 25 studies included in the review were inconsistent across both studies and measurements. This review has established a foundation of the relevant evidence Improved evaluation design is required to better understand what strategies work for whom, what components are essential and what measures are reliable Environmental change strategies and/or settings based approach may be the place to start for further research
  • 35. Questions?
  • 36. Posting BoardFor a copy of the presentation please visit our posting board: http://forum.health-evidence.ca/Login with your health-evidence username and password or register if you aren’t a member yet.
  • 37. Canadian Institutes of Health ResearchInstitute of Population and Public Health Funding Opportunities• Population Health Intervention Research to Promote Health and Health Equity• Knowledge Translation Awards• Institute Community Support Grants and Awards• CIHR’s Open Operating Grants Program 37
  • 38. Population Health Intervention Research ExampleEvaluation of traffic safety interventions in B.C.Jeffrey Brubacher, et. al (UBC)Looking at whether number of vehicle crashes changed afterchanges to the province’s Motor Vehicle Act.Findings will influence B.C.’s road safety strategy and will be ofinterest to traffic safety lawmakers from other Canadianprovinces and territories. 38
  • 39. • Visit ResearchNet for current CIHR funding opportunities: http://www.researchnet- recherchenet.ca/• For further information please contact us ipph-ispp@uottawa.ca 39

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